Psychiatrist Mardi Horowitz (1993) divided the process of going through trauma into five different phases. People go through these phases at different speeds; we all have different circumstances, personalities and ways of coping. Remember, the path you take is your own route. Think about these phases as a guide rather than a set process.
These stages are typical and can help you think about your experience and normalise the many different emotions you will be experiencing. However, it is not an exact science: the phases don’t occur for everyone or always in this exact order, and we commonly move back and forth between stages.
Here are the five stages of trauma (and how to recognise them):
Stage 1: Outcry
This is the shock stage, in which you feel overwhelmed by feelings in response to what’s happened. In this stage, what has happened can feel unbelievable, and there is little room for much else.
You might have a sense of things feeling surreal as your brain struggles to make sense of them. You might feel a mix of emotions, such as upset and anger. You might scream, yell or cry. Or hold in your feelings, suppressing them but feeling the rage inside. You might question why? or the unfairness of what has happened.
Life doesn’t stop for you, however, and in these early stages, it can feel like you only have enough energy to deal with what is urgent and no capacity for anything extra. This is a time of uncertainty, and everything feels out of control. You might have trouble managing your feelings, moving between experiencing strong emotions and feeling exhausted, tense, confused, empty and numb.
Intrusive memories, nightmares, poor sleep and flashbacks are also common.
At times you might glimpse the enormity of what has happened; the rest of the time, you are just coping. This is not the time to be looking for silver linings. This is the time to look after yourself, think about your needs, connect to others, find a sense of safety and seek medical or psychological support if needed.
A good night's sleep is one of the biggest health boosts you can get.
Stage 2: Numbness and denial
When you experience something that is incredibly upsetting, a common reaction is to try to push it out of your mind and avoid it. To try and move on and act as if nothing has happened, particularly if the emotions are tough ones like shame or terror, or if you were left feeling weak or vulnerable. This takes up a lot of energy and capacity.
In this stage, it can feel like you are in a dream or detached from what’s happening. You might also go on autopilot, moving through life as if nothing has changed, going through the motions as it’s all you know – working, taking care of your family, doing the things that are part of your normal day.
You might purposely keep busy so you have no time for yourself or to feel the pain, or numb yourself with drugs, alcohol or food. Many people describe a sense of feeling outside of themselves, watching from afar. Distant from family and friends, disconnected and disengaged from life.
You might not even be aware you are doing this. Sometimes people tell me it’s like they put up a wall to prevent themselves from being hurt more. This is essentially avoidance. When there is so much going on, and you don’t have the space to deal with it, some detachment is necessary to manage the distressing feelings.
You can only stay in this phase for so long before the memories start knocking and just won’t go away until they are dealt with.You may move between denial and intrusion – alternating between periods of distraction and disengagement and feeling what’s happened intensely. This can help break up the intensity of the loss so it is more manageable and lessoverwhelming
Stage 3: Intrusive re-experiencing
This is described by Horowitz as the phase of adjustment to trauma. Trauma activates threat mode in the part of the brain that is devoted to ensuring survival. It sits deep below our rational brain, so it is impossible to ignore in the long term.
We know this is a normal reaction to experiencing trauma, as our mind tries to work out what has happened and make sense of it. The experience can come back to us when we choose to think about it or as intrusive thoughts, flashbacks and nightmares. We may also experience intense physical sensations and emotions.
When we’re in this threat mode, we cannot access higher-level thinking and work things through. We have to calm ourselves physically before we can mentally engage with our recovery.
Our memories can feel painful, and unless we deal with them, they will keep having a negative effect on us.
Without alcohol, my feelings rarely hit those peaks of despair anymore.
Stage 4: Working through
As time progresses – this can be days, weeks, months or even years – the movement between denial (not thinking about or feeling the loss) and intrusion (thinking about it and feeling it intensely) tends to slow down, and we can work through what has happened and slowly fill in the gaps.
The intensity of the memory decreases. Often this happens naturally, rather than due to active effort, but it is key in allowing us to move forward. This is something you will see in all the stories in this book, which I would like to give you hope.
It is hard working through what has happened, but it’s the only way to truly let go of it. It is a chance to think about events, but to also start to figure out new ways to manage. You can’t go back to how things were – that reality doesn’t exist any more. It is only when you face up to the truth that you know what you are dealing with.
In this stage, acceptance and forgiveness takes place: acknowledging what has happened and the suffering it has caused, recognising that itmay have forever changed your life, expressing and owning your feelings of sorrow, loss, resentment or anger. Grieving for what’s happened is an important part of making sense of it and finding a way to put it away.
This process is similar to the grief model developed by Elisabeth Kübler-Ross. The five stages of grief – denial, anger, bargaining, depression and acceptance – are a useful guide for understanding some of the reactions you might have in response to loss.
The stages are similar to the five phases of trauma, as they are also non- linear and not everyone experiences every stage. Grieving your losses as you let go of the life you knew sits alongside taking responsibility for your actions, allowing you to move forward and free up more mental space.
Stage 5: Completion
At some point, the process of grieving is completed enough that life starts to feel normal again. The feelings attached to what has happened are less painful, and any active trauma memories move into long- term memory so they do not continue to bother us in the same way. We can file them away and look at them only when we choose to.
We might feel the loss more strongly on key dates, or when we see something that reminds us of what happened, but we will no longer feel it at the same intensity. Completion allows space to look past the difficulty and value the positive changes.
Extracted from How To Overcome Trauma and Find Yourself Again by Dr Jessamy Hibberd (£16.99, Aster).
It’s shame that seems to spring from even very slight or common social missteps, wrong moves, or misunderstandings.
